A tall, thin 20-year-old male attends the Emergency Department (ED) complaining of 3 days of intermittent chest pain. He describes the pain as occurring mostly on deep inspiration and slightly on movement but does not recall any chest wall trauma. He has no past medical history of note. Clinical examination of the cardiovascular and respiratory systems is normal. You cannot elicit any chest wall tenderness and the ECG is normal.
His observations are:
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Your clinical suspicion is that the patient may have a spontaneous pneumothorax and you arrange for a chest radiograph to be taken.
What is your diagnosis?
Despite the young man denying breathlessness you are aware that large pneumothoraces (>2 cm) require intervention. According to the BTS guidelines, should you aspirate or drain this primary spontaneous pneumothorax?
Complete the following sentence:
Aspiration should be performed until the patient coughs, no more can be aspirated or when…
You request a repeat chest radiograph, which shows that the pneumothorax is now approximately 1cm in size. As your aspiration is successful, what should you do next?
The patient says that he is going to Sharm-El Sheikh on a diving trip in 3 weeks time. When can he fly?
When can the patient go diving?
Who should review this patient and when?
What other important discharge advice would you give?
List five situations where referral to, or follow up by, cardiothoracic surgery is recommended for a patient with a spontaneous pneumothorax.